Basic Information
| Provider Information | |||||||||
| NPI: | 1477791663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6712 KIMBALL DRIVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Practice Location | |||||||||
| Address1: | 6712 KIMBALL DRIVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2009 | ||||||||
| LastUpdateDate: | 01/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2234 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.